Chapter 48: Treatment of Heart Failure Flashcards
What are some of the common causes of heart failure?
chronic hypertension, MI, valvular heart disease, coronary artery disease, congenital heart failure, dysrhythmias, and aging of the myocardium
What are some signs/symptoms of heart failure?
S/S of heart failure include: fatigue, SOB, exercise intolerance, venous distension, peripheral edema, pulmonary edema, tachycardia, weight gain, hepatomegaly, and cadiomegaly. ** lung crackles, low pulse oximetry, and RR may be elevated with pulmonary edema.**
Which combination of drugs is first line for its treatment?
Diuretics, RAAS inhibitors, and beta blockers are used in combination as a first-line treatment of heart failure.
What is the drug Digoxin used for? What are its most serious adverse effects?
Digoxin: this drug creates a positive ionotropic action in the heart, increases force of ventricular contraction, and increases cardiac contractility.
The most serious adverse effects of Digoxin include: cardiac dysrhythmias. ** this presents a unique irony in that this drug is used to TREAT dysrhythmias, yet it can induce the very problem it is designed to treat.
What are the S/S of Digoxin toxicity?
S/S of Digoxin toxicity: Dysrhythmias, N/V, anorexia, fatigue, and visual disturbances (yellow halos around objects, blurred vision).
What is the antidote for Digoxin toxicity?
Antidote for Digoxin toxicity includes: stoppage of the drug, replete potassium, lidocaine or phenytoin for dysrhythmias. (these interventions are used to treat the dysrhythmia) Digiband is used for severe toxicity as this binds up the drug in the serum.
What effect does Digoxin have on the force of cardiac contraction? on the heart rate? renal blood flow and urine output?
Digoxin increases the force of ventricular contraction, cardiac output as a result urine production increases, and renin release declines, which results in decreased vasoconstriction and blood volume.
How should a patient be monitored if we are giving him IV Digoxin?
The patient must be on telemetry with continuous cardiac monitoring for at least 1-2 hours following the IV injection.
What are the two “bad actors” responsible for much of the cardiac remodeling?
Angiotensin II and Aldosterone
How does a drug like spironolactone or eplerenone improve survival in a patient with heart failure?
Spironolactone is a diuretic that is potassium sparing and aldosterone blocking. Eplerenone is an aldosterone antagonist. Both of these drugs improve survival rates after heart failure, because they reduce HF symptoms, increase exercise tolerance, decrease hospitalization, thereby decreasing mortality rates.
